Provider Demographics
NPI:1588677934
Name:UNIVERSITY OF MARYLAND PEDIATRICS ASSOC PA
Entity Type:Organization
Organization Name:UNIVERSITY OF MARYLAND PEDIATRICS ASSOC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PROFESSIONAL FEES
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-706-5181
Mailing Address - Street 1:PO BOX 62063
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-2063
Mailing Address - Country:US
Mailing Address - Phone:410-706-5181
Mailing Address - Fax:410-706-5103
Practice Address - Street 1:655 W BALTIMORE ST
Practice Address - Street 2:BRB7-042
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1509
Practice Address - Country:US
Practice Address - Phone:410-706-5181
Practice Address - Fax:410-706-5103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD435128200Medicaid
MD435128200Medicaid